Body Surface Area-Based Chemotherapy Dosing in a Pediatric Acute Lymphoblastic Leukemia Patient: A Detailed Case Report
Keywords:
Pediatric Acute Lymphoblastic Leukemia, BSA-based Chemotherapy, Modified BFM Protocol, Vincristine, Chemotherapy Dosing, Pediatric OncologyAbstract
Acute Lymphoblastic Leukemia (ALL) is the most common childhood hematological malignancy, with a virtually 25% incidence of all cancers in children. Precise chemotherapy dosing in children is necessary to provide optimum efficacy without the occurrence of side effects. Among all the techniques used to determine the dose, dosing based on Body Surface Area (BSA) is the most optimal method in children, particularly for cytotoxic drugs with narrow therapeutic windows. This case report describes a 6-year-old girl who was diagnosed with precursor B-cell Acute Lymphoblastic Leukemia. With classic symptoms of weakness, pallor, and hepatosplenomegaly, the diagnosis was established using complete blood count, peripheral smear, bone marrow aspiration, and flow cytometry. The patient was categorized as standard risk and was treated with a modified Berlin-Frankfurt-Münster (BFM) regimen. Her body surface area (BSA) was calculated as 0.8 m² using the Mosteller formula, and chemotherapy agents such as vincristine, daunorubicin, dexamethasone, and L-asparaginase were administered based on this value. Supportive measures included hydration, prophylaxis for tumour lysis, antimicrobial therapy, and close monitoring of hematological and biochemical parameters. The patient tolerated induction well without major complications, such as mucositis or transient liver enzyme elevation. There were no episodes of febrile neutropenia, and remission was achieved on day 19 of treatment, indicating effective and well-tolerated induction. This case illustrates the applicability of BSA-based dosing in pediatric oncology by emphasizing the manner in which it offers a physiologically rational approach to dose calculation relative to weight-based dosing strategies. It also emphasizes the clinical value of formal treatment protocols, such as BFM, in resource-constrained settings. The report also considers emerging trends toward combining pharmacogenomics and therapeutic drug monitoring as a vehicle for further personalizing pediatric dosing regimens. In summary, this case reaffirms the continued applicability of BSA-based dosing as the standard for safe and effective pediatric chemotherapy.
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References
Hunger SP, Mullighan CG. Acute lymphoblastic leukemia in children. N Engl J Med. 2015;373(16):1541–52.
Inaba H, Greaves M, Mullighan CG. Acute lymphoblastic leukemia. Lancet. 2013;381(9881):1943–55.
Pui CH, Yang JJ, Hunger SP, Pieters R, Schrappe M, Biondi A. Childhood acute lymphoblastic leukemia: Progress through collaboration. J Clin Oncol. 2015;33(27):2938–48.
Mosteller RD. Simplified calculation of body surface area. N Engl J Med. 1987;317(17):1098.
Veal GJ, Hartford CM, Stewart CF. Clinical pharmacology in the management of pediatric cancers. Clin Pharmacol Ther. 2010;88(1):18–24.
De Moerloose B, Suciu S, Bertrand Y, Ferster A, Grillot-Courvalin C, Mazingue F, et al. Improved risk classification for children with acute lymphoblastic leukemia: Long-term results of the EORTC 58951. Blood. 2010;115(20):3715–22.
Holford NHG, Ma SC, Piana C, et al. Pharmacokinetics in children: An overview. Br J Clin Pharmacol. 2022;88(5):1800–1810.
Reaman GH. Pediatric oncology: Progress and challenges. Pediatric Clin North Am. 2008;55(1):1–20.
Gidding CE, Meeuwsen-de Boer GJ, Koopmans P, et al. Vincristine-induced peripheral neuropathy in children with cancer: A review. Crit Rev Oncol Hematol. 1999;29(3):187–97.
Schmiegelow K, Forestier E, Hellebostad M, et al. Long-term results of NOPHO ALL-92: a randomized study of childhood acute lymphoblastic leukemia Blood. 2010;115(20):3715–22.
Pizzo PA, Poplack DG. Principles and Practice of Pediatric Oncology. 7th ed. Philadelphia: Lippincott Williams & Wilkins; 2016.
FDA Pediatric Pharmacology Draft Guidance. Considerations for Pediatric Dosing and Trial Design. U.S. Food and Drug Administration; 2021.
Relling MV, Evans WE. Pharmacogenomics in the clinic. Nature. 2015;526(7573):343–50.
Hempel G, Boos J. Therapeutic drug monitoring in childhood ALL: A tool for safer treatments. Cancer Chemother Pharmacol. 2007;59(4):459–65.
Kearns GL, Abdel-Rahman SM, Alander SW, Blowey DL, Leeder JS, Kauffman RE. Developmental pharmacology: Drug disposition, action, and therapy in infants and children. N Engl J Med. 2003;349(12):1157–67.
Relling, MV, Schwab, M, Whirl-Carrillo, M, Clinical Pharmacogenetics Implementation Consortium (CPIC) guidelines for thiopurine dosing. Clin Pharmacol Ther. 2013;93(4):324–9.
Lovell R, Martin S, et al. Nutritional status and drug metabolism in pediatric oncology. Pediatric Blood Cancer. 2025;72(2): e30871.
Lambert J, Hain RDW. When is the weight insufficient? Complexities of drug dosing in children. Arch Dis Child. 2016;101(2):167–71.
Pieters R, Hunger SP, Boos J, et al. L-asparaginase treatment in ALL: Clinical use and patient monitoring. Blood. 2011;117(13):3394–400.
Bhakta N, Liu Y, Yang W, et al. Pharmacokinetics and individualized dosing of chemotherapy in pediatric acute lymphoblastic leukemia: A multicenter approach to precision medicine. Lancet Haematol. 2023;10(2): e89–e98.
Saha A, Kumar A, et al. Pediatric oncology in low- and middle-income countries: Reflections from India. Indian J Med Paediatric Oncol. 2012;33(1):8–15.
Gupta S, Howard SC, et al. Treating childhood cancer in low- and middle-income countries: JCO Glob Oncol. 2020; 6:785–99.
Yang JJ, Bhojwani D, Yang W, et al. Genome-wide copy number profiling in pediatric ALL. Blood. 2021;138(10):830–841.
Paugh SW, Yang W, Pui CH, et al. Pharmacogenomics of early relapse in childhood ALL. Clin Pharmocol Ther. 2019;105(3):575–83.
Children’s Oncology Group (COG). ALL Treatment Protocols and Guidelines. Updated 2024. Available from: https://childrensoncologygroup.org/
Xu J, Chen Y, Wang L, et al. Machine Learning Models Predict Chemotherapy Dosing Outcomes in Pediatric Oncology: A Multi-Centre Study. Front Oncol. 2023; 13:1152345.
Mehta V, Singh A, et al. Emerging Biomarkers for Optimizing Chemotherapy in Pediatric Acute Lymphoblastic Leukemia: A Systematic Review. J Clin Med. 2023;12(14):4839.
Patel S, Agarwal R, Chandra S, et al. Real-world Data on Chemotherapy Dosing Practices in Pediatric Oncology: Insights from a Multi-centre Registry. BMC Cancer. 2024; 24:512.
Zhang X, Li W, Xu R, et al. Systematic Review of Body Surface Area vs Weight-Based Dosing in Pediatric Chemotherapy: Limitations and Future Directions. Pediatric Blood Cancer. 2023;70(7): e31055.
Kim YJ, Park JS, et al. Pharmacogenomics-Driven Chemotherapy in Pediatric ALL: Clinical Trial Advances and Future Directions. Clin Pharmocol Ther. 2024;115(1):70–81.
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